Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

Abstract

Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided.

Syndecan-1 in Acute Decompensated Heart Failure – Association With Renal Function and Mortality –

“…19 Briefly, AKI stage 1 included acute SCr increases ≥0.3 mg/dl and up to 200% above the stable baseline SCr, whereas values of SCr in the range of 200-300% greater than the stable baseline level were considered as AKI stage 2. AKI stage 3 entailed acute increases of SCr to more than 300% (>3-fold), as well as SCr values ≥4 mg/dl while showing an acute increase of at least 0.5 mg/dl.…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…198 Susceptibility to developing AKI after exposure to a specific insult has been identified according to a number of observational studies. 199 The most frequent causes for AKI in hospitalized cardiac patients relate to the combination of a low cardiac output/high venous pressure, and/or the administration of iodinated contrast media during diagnostic and interventional vascular procedures. Contrast-induced AKI (CI-AKI) is defined as a rise of serum creatinine of 44 mmol/L (0.5 mg/dL) or a 25% relative rise from baseline at 48 hours (or 5 -10% at 12 hours) following contrast administration.…”

Biomarkers for AKI improve clinical practice: yes

“…This renal complication is associated with high morbidity, high short-term and longterm mortality and a tremendous economic impact [1,2]. Prevention and treatment of AKI mainly rely on hemodynamic optimization and avoidance of nephrotoxic agents [3]. Specific preventive or curative strategies or medications tested in this field over the last decades have been either inefficient or insufficiently validated to be routinely recommended [3].…”

“…Prevention and treatment of AKI mainly rely on hemodynamic optimization and avoidance of nephrotoxic agents [3]. Specific preventive or curative strategies or medications tested in this field over the last decades have been either inefficient or insufficiently validated to be routinely recommended [3]. One of the numerous reasons that may explain this failure is the unavoidable late recognition of renal injury leading to delayed interventions.…”